Senior Psychcare

More than 70% of primary care visits are linked to psychosocial issues, such as anxiety and depression. Although very few primary care physicians currently have the assets to help patients deal with those concerns, a new program at the Harvard Medical School Center for Primary Care may show that investing in those services is advantageous both for the provider and the patient.

As part of the Center’s Academic Innovations Collaborative, six of the 18 medical practices under the center will integrate behavioral health services into their primary care services. The effort is funded through a two-year grant, and the other twelve sites can apply the coming year.

Russ Phillips, MD, director of the Center for Primary Care at Harvard Medical School, states that it’s not that primary care doctors don’t wish to monitor for mental health disorders, but that they aren’t set up to deal with the findings.

“Screening is only worth doing if you have the resources within your practice to actually deal with problems that you identify,” he says. “Traditionally, behavioral health has been sort of marginalized, and individuals have been treated separately from those with bodily health concerns. But we realize psychological health issues present frequently in primary care and complicate the treatment of patients with various other medical disorders. So attempting to incorporate those services into primary care practices is sensible.”

The program creates a network of staff within the practice to actively connect with patients and to evaluate their status. It will also offer practices with social workers who can counsel patients, and mental health specialists who physicians can consult if their clients don’t respond to initial treatment.

Phillips says primary care practices may benefit from offering behavioral health services in three different ways:

• Improved patient wellness – By addressing mental health challenges with their primary care physician, Phillips says patients will likely see far better outcomes in their overall health. “Mental health disorders complicate the care of patients with any serious medical condition, such as diabetes or heart failure,” he says. “If you’re despondent and feeling overwhelmed, t’s a lot more challenging to monitor your health and to take your medicine.”
• Reduced physician burnout – “I have been a primary care physician for 35 years and for many of us it can feel pretty lonely because often we’re working by ourselves,” Phillips says. “We don’t have resources. We have patients come to us with problems that we may not feel prepared to address. A way that this new program will be particularly beneficial is we’ll also be offering trainings for groups within primary care practices to enhance their degree of knowledge in taking care of mental health problems. ”
• Reduced costs of care – “We know treating depressive disorders can improveresults, which will reduce emergency room visits and hospitalizations,” Phillips says. “Often times costs for patients with diabetes who in addition have depression are amplified by about 20%. If you cure that depression, you can save that amount of money in addition to making patients healthier and feel better.”

Even though this program is grant-funded, Phillips predicts that it will be financially sustainable with time, and he hopes the outcomes will encourage other primary care practices to consider providing these services.

“One of the items we anticipate is there will be a beneficial return on investment, which means the money we spend will be much less than the savings that will be accrued by offering these services,” says Phillips. “So it will be a win-win for businesses to take on providing these resources in the foreseeable future. We anticipate there will be new payment programs through accountable care establishments, and institutions will have the ability to commit assets to areas where they’ll attain cost savings.”